Random q's for the mws -- or smarter doulas than me! LOL

[DoomaYula]

Just those q's that keep me awake at night:

1. So, obvs the supine position isn't the best for pushing -- but why is anything that ISN'T vertical better than supine? Like, why is side-lying better? Or on all 4s? You're still not getting much help from gravity in those positions either, right?

2. I've read anecdotally about cytotec for pph is given rectally... do hospitals ever do this? I've never seen it.

3. Hmmm I thought I had 3, maybe not... I'll write it down tonight!

[Jane]

Yeah, I've seen rectal misoprostol.

[memiles]

It's not only a gravity issue. Supine position puts weight on the tailbone so it's not able to move out of the way, and doesn't really allow the pelvis to open effectively. Side lying allows the tailbone to be flexible and the pelvis to move, as does hands and knees. It's all about allowing the bones to move out of the way.

[zofranland]

not a mw or doula, i am an L&D nurse and WHNP. my hospital uses 1000mg rectally. it causes some massive diarrhea! we also use hemabate too which is just as bad!

[Reha]

Originally Posted by memiles

It's not only a gravity issue. Supine position puts weight on the tailbone so it's not able to move out of the way, and doesn't really allow the pelvis to open effectively. Side lying allows the tailbone to be flexible and the pelvis to move, as does hands and knees. It's all about allowing the bones to move out of the way.

: but it also is like pushing up hill when supine. I think if it has to be a horizontal bed-birth, side lying is much better than supine.

But, I am a much bigger fan of being upright, whatever that may be for the mother (standing, squatting, hands and knees, birth stool, kneeling, etc.)

[momileigh]

I've seen rectal cytotec.

[MsBlack]

The thing about pushing is that it isn't JUST about getting help from gravity, because the uterus is an incredibly powerful muscle and it doesn't often 'need' gravity's help (though supine, against gravity, is definitely not good). Yes, I'm a fan of upright positions in many cases, but not in all. For a primip with a tight perineum, it can actually be better if she is sidelying or hands and knees, or even a mild knee chest slant--no need to allow gravity to speed descent if you want descent nice and slow for the sake of the perineum's ability to stretch enough to prevent tearing.

Also, apart from the power of the uterus and gravity's effects, there is the question of 'other' muscular resistance on the part of a mom. sometimes, sidelying can help her relax entirely, between and even with pushing contrax...remember, we are not forcing toothpaste through a tube, we're hoping for a mom to open and 'give' birth...let her body give way to baby's progress.

If I have any reason to think Shoulder Dystocia is possible for a mom/baby, then I also prefer not to add gravity to the mix. Again, you don't want too much force bringing baby's shoulder too tightly against that pubic bone--and the more relaxed mom can be, the less likely impaction will happen, or at least become real bad.

Sometimes, sidelying is best in helping baby find the way through the maze, as it were. And can produce the very strongest of all contrax--this varies by individual, of course. But there is no one position or type of position that works best for all, in terms of comfort, stretching perin., baby dancing descent, and/or power of contrax.

Other than telling women in advance as well as when 2nd stage starts that they probably ought to avoid supine/reclined positions that put weight on the tail/sacrum, I mainly invite women to find what feels best. Will suggest specific positions if needed, but usually women find what works/feels best for themselves without my 'coaching'.

[mwherbs]

Originally Posted by MsBlack

Other than telling women in advance as well as when 2nd stage starts that they probably ought to avoid supine/reclined positions that put weight on the tail/sacrum, I mainly invite women to find what feels best. Will suggest specific positions if needed, but usually women find what works/feels best for themselves without my 'coaching'.

yep-- actually your whole post but this in particular- women figure out what they want to do-- they really do- once in a while a suggestion is helpful or useful.
now I want you to try something put your hand on one of your ischial spines now sit on it or lean back - and even try opening your legs wide and see what that feels like and where it is -- to me when I put my knees wide open and I am sitting on my spines- my tail bone is being pressed from the outside- and my ischial spines actually feel to me like they have made a narrower opening-- but it probably also gives a little slack on the ligaments that go from the ischum to the sacrum when my knees are about shoulders width apart the spines seem in a neutral position and off a surface they are not being pressed at all- if you lay sideways those spines (where 0 station is) noting is on the spines either infact I can hardly feel my ischial spines when laying down because the muscles stop being tense around -- so with a baby getting to a +1 station it's presenting part is 1 cm beyond your spines how much room beyond the spines is there for a presenting part ? how about against a surface? --- hands and knees you can and do hold your ischial spines closer to a neutral position and there is room for a presenting part to move as many centimeters past your spines as needed--